The use of pericardium for the management of recurrent tracheoesophageal fistula

Correction of congenital esophageal atresia and tracheoesophageal fistula (TEF) with either a primary or staged repair may result in recurrence of the TEF, most often at the site of esophageal anastomosis. Definitive operative repair of a recurrent TEF involves isolation and resection of the fistula with closure of the tracheal and esophageal defects. A technique is described, whereby mobilization of a vascularized pedicle of pericardium allows further enhancement of the standard repair of a recurrent TEF. The vascularized pedicle of pericardium serves to isolate the tracheal and esophageal suture lines from each other, as well as aid in sealing leaks at either or both suture lines. This may dramatically reduce the incidence of second recurrences and lower the overall operative mortality, reportedly as high as 59%.